The present invention generally relates to health related disorders. More particularly, the invention provides a method and apparatus for managing behaviors related to sleep disorders. Merely by way of example, the invention is applied using digital hardware and software.
Sleep apnea is a common disorder associated with severe adverse health consequences in some patients. It is generally recognized that continuous positive airway pressure (CPAP) and other forms of positive airway pressure (PAP) can be effective treatments for the obstructive type of sleep apnea (OSA). Unfortunately, studies have found that compliance with CPAP among OSA patients is poor [L. GROTE, et. al. Therapy with nCPAP: incomplete elimination of sleep related breathing disorder. Eur Resp J. 2000; 16:921-7.] [N. McARDLE, et. al. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999; 159(4 Pt 1):1108-14.].
The medical profession often views non-compliance or under-compliance with advice/ecommendations from a healthcare professional as undesirable, i.e. a “negative” behavior on the part of the patient. Thus, there have been efforts to increase CPAP/PAP compliance among OSA patients. Some such efforts have, for example, employed alternate types of facemasks, humidified air, alternate pressure schedules (e.g. bi-level positive airway pressure), and the like. Compliance-enhancing efforts have also included support or behavioral-cognitive elements [C. J. HOY, et. al. Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome? Am J Respir Crit Care Med. 1999; 159(4):1096-1100.].
In their review of CPAP compliance, Zozula and Rosen [R. ZOZULA, R. ROSEN. Compliance with continuous positive airway pressure therapy: assessing and improving treatment outcomes. Curr Opin Pulm Med. 2001; 7(6):391-8.] observe: (1) Motivational factors are strongly associated with both acceptance of the diagnosis of OSA, as well as overall treatment compliance; (2) Evidence suggests that patients' initial perception of improvement after initiating CPAP therapy is a strong predictor of subsequent treatment compliance use; (3) Successful compliance is often affected by the type and degree of patient education about the specific medical condition; (4) Initial perceptions are often decisive; therefore the timing of an intervention aiming to increase compliance is essential; (5) There is an increasing demand to find effective interventions to increase CPAP compliance.
Zozula and Rosen further note that social-psychological models are used widely to account for patient behavior change in medical settings. As one example, they summarize the “stages of change” model (usually attributed to Prochaska), in which individuals progress through predictable psychological stages in their efforts to adopt new health-related behaviors. Under the Prochaska model, a patient who transitions to a stage characterized by greater readiness to change is more apt to adopt new behaviors.
Issues of compliance and other patient behaviors are not restricted to OSA or CPAP. In general, any phase of a diagnostic or therapeutic process that requires action from a patient (or the patient's caretaker) may carry a risk of noncompliance. Some patients, for example, may delay action until convinced they have a problem. Furthermore, convincing some patients that they have a problem can be difficult, especially those unwilling to accept a physician's pronouncement of illness without accompanying proof they can understand. This difficulty may be a significant factor in many patients having a sleep disorder associated with no noticeable manifestations during or only minor noticeable manifestations wakefulness.
In the case of snoring, recording and playing back the sounds of a person's snoring have been used to prove to the person that they snore. There are limitations, however, to expanding the use of this technique for snoring and to extending this general approach to laypersons having other sleep disorders such as sleep apnea.
For example, although the sound of snoring is generally recognized correctly and readily by many laypersons, other abnormal sleep breathing events (e.g. hypopneas and respiratory effort related arousals) most likely cannot be readily and correctly recognized from their sound by the vast majority of laypersons without explanation or training. This suggests that mere audio recording and playback of sleep breathing sounds will have little influence on the behavior of an untrained lay patient who has a sleep disorder predominantly characterized by these pathological events.
An additional shortcoming arises because events associated with sleep disorders may vary in occurrence and severity during the course of a sleep period. For example, a sleeping person may snore at some times and not at others during the night. As an additional example, a sleeping person may have frequent apneas in the hours just before awakening, but not in the hours immediately after going to bed. Thus, proper characterization of a patient's sleeping may require assessment of audio recordings that span several hours of patient sleep time. Because human attention spans are generally limited, most people are unlikely to listen to such recordings for periods of hours.
From the above, it is desirable to have improved techniques for managing health related disorders. It is also desirable to have improved techniques to increase compliance with therapy and/or lead to other desired behavioral changes.